Therapy services to treat, for example, depression caused by an under-functioning thyroid is unlikely to be effective. Routine physical activity is known to promote positive mental wellness, while inadequate or excessive physical activity can contribute to different types of mental health struggles. Francisco A. Montiel Ishino and Faustine Williams, and Ms. Bonita Salmeron was supported by the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily reflect the views of the National Institutes of Health. We performed descriptive analyses to detail the characteristics of NSDUH sample participants.

  • All the informants had received professional support or therapy after they left inpatient SUD treatment, including economic support, work training, housing, trauma therapy, detox or inpatient treatment.
  • A subsequent 2000 paper by McLellan et al. [2] examined whether data justify distinguishing addiction from other conditions for which a disease label is rarely questioned, such as diabetes, hypertension or asthma.
  • However, applying this model to addictive behavior provides a clearer understanding of the functional relationships in addiction to chart a path forward.
  • Why do individuals choose the pathological choice of using drugs at the expense of taking care of oneself and loved ones, of sacrificing personal relationships, of destroying one’s social environment.
  • In the worst-case scenario, clients will recreate a drug culture among themselves within the program.

Epidemiologically, it is well established that social determinants of health, including major racial and ethnic disparities, play a significant role in the risk for addiction [75, 76]. Contemporary neuroscience is illuminating how those factors penetrate the brain [77] and, in some cases, reveals pathways of resilience [78] and how evidence-based prevention can interrupt those adverse consequences [79, 80]. In other words, from our perspective, viewing addiction as a brain disease in no way negates the importance of social determinants of health or societal inequalities as critical influences. In fact, as shown by the studies correlating dopamine receptors with social experience, imaging is capable of capturing the impact of the social environment on brain function. This provides a platform for understanding how those influences become embedded in the biology of the brain, which provides a biological roadmap for prevention and intervention. In recent years, the conceptualization of addiction as a brain disease has come under increasing criticism.

Understanding Own Substance Use

The criminality variable was based on if the participant had been arrested and booked for breaking the law, excluding minor traffic violations. Booked was defined as being taken into custody and processed by the legal system, even if the participant was later released. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY).

The present paper is a response to the increasing number of criticisms of the view that addiction is a chronic relapsing brain disease. In many cases, we show that those criticisms target tenets that are neither needed nor held by a contemporary version of this view. Common themes are that viewing addiction as a brain disease is criticized for being both too narrow (addiction is only a brain disease; no other perspectives or factors are important) or too far reaching (it purports to discover the final causes of addiction). With regard to disease course, we propose that viewing addiction as a chronic relapsing disease is appropriate for some populations, and much less so for others, simply necessitating better ways of delineating the populations being discussed.

The clinical application of the biopsychosocial model.

In other cases, we believe the arguments have less validity, but still provide an opportunity to update the position of addiction as a brain disease. Our overarching concern is that questionable arguments against the notion of addiction as a brain disease may harm patients, by impeding access to care, and slowing development of novel treatments. Placing addiction at the center of this model reveals how addiction is greater than the sum of its parts. The factors that have causal influences on addictive behavior do not operate independently but are part of a complex network that both directly and indirectly influence addictive behavior ad infinitum. Once these factors begin to set the occasion for addictive behavior, a series of interdependent events begin to unfold, with each event further increasing drug intake, and making the other events all the more effective at increasing drug use further.

  • Factors such as drug availability within the environment can increase craving and consequently the vulnerability for relapse (Weiss 2005).
  • Media portrayals, along with singer or music group autobiographies, that glamorize the drug lifestyle may increase its lure (Manning 2007; Oksanen 2012).
  • This option is particularly helpful when the client’s connection to a drug culture is relatively weak and his or her traditional culture is relatively strong.
  • All sociodemographic and biopsychosocial characteristics, as well as other substance dependence or abuse were tested independently in unadjusted models to examine the relationship of each characteristic on opioid misuse.
  • From a neuroscience perspective, it is difficult to see such actions as completely free, particularly when explanations of natural phenomena are understood as causally ordered.

It originates from within the scientific community itself, and asserts that this conceptualization is neither supported by data, nor helpful for people with substance use problems [4,5,6,7,8]. Addressing these critiques requires a very different perspective, and is the objective of our paper. We readily acknowledge that in some cases, recent critiques of the notion of addiction as a brain disease as postulated originally have merit, and that those critiques require the postulates to be re-assessed and refined.